Titan User Guide

Manufactured by
SonoSite, Inc. 21919 30th Drive SE Bothell, WA 98021 USA T: 1-888-482-9449 or 1-425-951-1200 F: 1-425-951-1201
SonoSite Ltd Alexander House 40A Wilbury Way Hitchin Herts SG4 OAP UK T: +44-1462-444800 F: +44-1462-444801
“TITAN ” and “SonoSite TITAN ” are trademarks of SonoSite, Inc.
Kensington is a registered trademark of Kensington Technology Group.
CompactFlash is a registered trademark of Symbol Technologies.
Non-SonoSite product names may be trademarks or registered trademarks of their respective owners.
SonoSite products may be covered by one or more of the following U.S. patents: 4454884, 4462408, 4469106, 4474184, 4475376, 4515017, 4534357, 4542653, 4543960, 4552607, 4561807, 4566035, 4567895, 4581636, 4591355, 4603702, (4607642), 4644795, 4670339, 4773140, 4817618, 4883059, 4887306, 5016641, 5050610, 5095910, 5099847, 5123415, 5158088, 5197477, 5207225, 5215094, 5226420, 5226422, 5233994, 5255682, (5275167), 5287753, 5305756, 5353354, 5365929, 5381795, 5386830, 5390674, 5402793, (5,423,220), 5438994, 5450851, 5456257, 5471989, 5471990, 5474073, 5476097, 5479930, 5482045, 5482047, 5485842, 5492134, 5517994, 5529070, 5546946, 5555887, 5603323, 5606972, 5617863, (5634465), 5634466, 5636631, 5645066, 5648942, 5669385, (5706819), 5715823, 5718229, 5720291, 5722412, 5752517, 5762067, 5782769, 5800356, 5817024, 5833613, 5846200, 5860924, 5893363, 5916168, 5951478, 6036643, 6102863, 6104126, 6113547, 6117085, 6142946, 6203498 B1, 6371918, 6135961, 6364839, 6383139, 6416475, 6447451, 6471651, 6569101, 6575908, 6604630, 6648826, D0280762, D0285484, D0286325, D0300241, D0306343, D0328095, D0369307, D0379231, D456509, D461895. Other patents pending.
P03322-07 11/2004
All rights reserved. Printed in the USA.

System Controls .......................................................................................14 Screen Layout ..........................................................................................16 General Interaction .................................................................................18
iv
Image Storage .......................................................................................... 60 Save to CompactFlash .................................................................... 60 Print to Local Printer ...................................................................... 60
Image Review .......................................................................................... 61 Patient List ....................................................................................... 61 Patient Images ................................................................................. 62
Chapter 4: Measurements and Calculations
Measurements ......................................................................................... 63 2D Measurements ........................................................................... 63 M Mode Measurements ................................................................. 65 Doppler Measurements .................................................................. 68
Calculations ............................................................................................. 72 Percent Reduction Calculations .................................................... 72 Volume Calculation ........................................................................ 74 Volume Flow Calculation .............................................................. 76 Gyn Calculations ............................................................................. 78 OB Calculations ............................................................................... 81 Vascular Calculations ..................................................................... 89 Cardiac Calculations ....................................................................... 92
Patient Report ....................................................................................... 101
Chapter 5: DICOM Connectivity
TITAN System Setup for DICOM ...................................................... 105 Ethernet Connection ............................................................................. 105 DICOM Setting Backup ....................................................................... 105 DICOM Configuration ......................................................................... 106
Configuring Locations .................................................................. 106 Configuring Archivers ................................................................. 109 Configuring Printers ..................................................................... 112 Configuring Worklist Servers ..................................................... 116 Configuring Procedures ............................................................... 119 Importing and Exporting Configurations ................................. 120 Reviewing the Network Log ....................................................... 121
DICOM Usage ....................................................................................... 122 DICOM Image Archive and Print .............................................. 124 Patient Information ....................................................................... 126 DICOM Worklists ......................................................................... 127
Chapter 6: Safety
Ergonomic Safety .................................................................................. 129 Electrical Safety ..................................................................................... 129 Equipment Safety ................................................................................. 131 Battery Safety ........................................................................................ 131 Biological Safety .................................................................................... 132 Electromagnetic Compatibility (EMC) .............................................. 133
Manufacturer’s Declaration ......................................................... 134
Intended Uses ........................................................................................142 About the Acoustic Output Table .......................................................144
Labeling Symbols ..................................................................................158
Troubleshooting ....................................................................................161 Software Licensing ................................................................................163 Obtaining a License Key ......................................................................169 Installing a License Key ........................................................................170 Maintenance ...........................................................................................171
Chapter 9: Specifications
System Dimensions .............................................................................. 203 Display Dimensions ............................................................................. 203 Transducers ........................................................................................... 203 Imaging Modes ..................................................................................... 203 Applications .......................................................................................... 204 Image Storage ........................................................................................ 204 Accessories ............................................................................................ 204
Hardware, Software, and Documentation ................................ 204 Cables .............................................................................................. 205
Peripherals ............................................................................................. 205 Medical Grade ............................................................................... 205 Non-Medical Grade ...................................................................... 205
Temperature, Pressure, and Humidity Limits ................................. 205 Operating Limits: System ............................................................ 205 Shipping/Storage Limits: System without Battery .................. 205 Operating Limits: Battery ............................................................ 205 Shipping/Storage Limits: Battery .............................................. 205 Operating Limits: Transducer ..................................................... 206 Shipping/Storage Limits: Transducer ....................................... 206
Electrical ................................................................................................. 206 Battery .................................................................................................... 206 Electromechanical Safety Standards .................................................. 206 EMC Standards Classification ............................................................ 206 Airborne Equipment Standards ......................................................... 207 DICOM Standard .................................................................................. 207 HIPAA Standard .................................................................................. 207
Chapter 10: Glossary
Chapter 1: Introduction 1
I n t r o d u c t i o n
Chapter 1: Introduction
Please read the information in this user guide before using the TITAN TM high-resolution ultrasound system. It applies to the ultrasound system, and transducers.
About the User Guide This user guide is a reference for using the ultrasound system. It is designed for a reader familiar with ultrasound techniques; it does not provide training in sonography or clinical practices. Before using the system, you must have ultrasound training.
The user guide covers the preparation, use, and maintenance of the ultrasound system, transducers, and accessories. Refer to the manufacturers’ instructions for specific information about peripherals.
The user guide includes a table of contents and an index to help you find the information that you need. The user guide is divided into the following chapters:
Chapter 1 “Introduction” Contains general information about the user guide and the system. Customer assistance information is also included.
Chapter 2 “Getting Started” Contains information on healthy scanning practices, basic operation, and changing system settings.
Chapter 3 “Imaging” Contains detailed information about preparing for the exam, entering patient information, adjusting imaging modes, annotating images, saving images and reviewing patient images.
Chapter 4 “Measurements and Calculations”
Contains information on performing measurements and calculations in the different imaging modes.
Chapter 5 “DICOM Connectivity”
Chapter 6 “Safety” Contains information required by various regulatory agencies, including information about the ALARA (as low as reasonably achievable) principle, the output display standard, acoustic power and intensity tables, intended uses, and other safety information.
Chapter 7 “Troubleshooting and Maintenance”
Contains information to assist in the correction of problems with system operation. Also contains information about proper care of the system, transducers, and accessories.

t i o n
Conventions Used in This User Guide These conventions are used in this user guide:
• A Warning describes precautions necessary to prevent injury or loss of life.
• A Caution describes precautions necessary to protect the products.
• When the steps in the operating instructions must be performed in a specific order, the steps are numbered.
• Bulleted lists present information in list format, but they do not imply a sequence.
• The system handle is on the front of the system, and the battery compartment is on the back of the system.
Symbols and Terms Used in This User Guide Symbols and terms used on the system, are explained in “Screen Layout” on page 16, Chapter 5, “DICOM Connectivity”and/or Chapter 10, “Glossary.”
Upgrades and User Guide Updates SonoSite may offer software upgrades, new features, and improvements to the system performance. User guide updates accompany the upgrade software and provide detailed information on the enhancements.
Customer Comments Questions and comments are encouraged. SonoSite is interested in your feedback regarding the system and the user guide. Please call SonoSite at 1-888-482-9449. If you are outside the USA, call the nearest SonoSite representative. You can also send electronic mail (e-mail) to SonoSite at the following address: [email protected].

About the System The ultrasound system has multiple configurations and feature sets. All are described in this user guide but not every option may apply to your system. System features are dependent on your system configuration, transducer, and exam type.
Figure 1 TITAN System Front View
5
4
3
1
2
Number Feature
3 Handle
4 Display
5 CompactFlash™ slots (front for image storage, back for system and transducers
updates, import/export OB tables, user names/passwords, and DICOM
configurations)
t i o n
Figure 2 TITAN System Back View
The TITAN system is a portable, software-controlled, ultrasound system using all-digital architecture. The system is used to acquire and display high-resolution, real-time ultrasound images: 2D, color power Doppler (CPD), directional color power Doppler (DCPD), Color Doppler (Color), Tissue Harmonic Imaging (THI), M Mode, pulsed wave (PW) Doppler, and continuous wave (CW) Doppler. The system has cine buffer, image zoom, labeling, biopsy, measurements, calculations, a USB connection for image transfer, image storage, image review, printing, recording, and the ability to archive Doppler with audio output to a videotape.
Currently, the system supports the following broadband transducers:
• C8/8-5 MHz 8 mm microcurved array
• C60/5-2 MHz 60 mm curved array
• HST/10-5 MHz 25 mm linear array
• ICT/8-5 MHz 11 mm intracavitary array
• L25/10-5 MHz 25mm linear array
• L38/10-5 MHz 38 mm linear array
System accessories include the following: TITAN mobile docking system, TITAN MDS Lite, TITAN mini-dock, Triple Transducer Connect, a power supply, a battery, ECG cable, video and printer cables, SiteLink Image Manager 2.2 software, and DICOM connectivity. See the TITAN Accessory User Guide for information on the accessories.
1
Number Feature
System peripherals include medical grade (conforming to the requirements of EN60601-1) and non-medical (commercial) grade products. System medical grade peripherals include a printer, VCR, and DVD. System non-medical grade peripherals include a CompactFlash card and a Kensington Security Cable. System setup instructions for the use of peripherals are covered in Chapter 2, “System Setup” on page 21.
Manufacturer’s instructions accompany each peripheral. Instructions for the use of peripherals with the system are covered in the TITAN Accessory User Guide.

t i o n
G e t t i n
g S t a r t e
d
This chapter contains information on healthy scanning practices, basic operation, and changing system settings.
Healthy Scanning Guidelines These guidelines are intended to assist you in the comfort and effective use of your ultrasound system.
Warning: Use of an ultrasound system may be linked to musculoskeletal disorders a,b,c.
Use of an ultrasound system is defined as the physical interaction between the operator, the ultrasound system, and transducer.
When using an ultrasound system, as with many similar physical activities, you may experience occasional discomfort in your hands, fingers, arms, shoulders, eyes, back, or other parts of your body. However, if you experience symptoms such as constant or recurring discomfort, pain, throbbing, aching, tingling, numbness, burning sensation, or stiffness, do not ignore these warning signs. Promptly see a qualified health professional. Symptoms such as these can be linked with musculoskeletal disorders (MSDs). MSDs can be painful and may result in potentially disabling injuries to the nerves, muscles, tendons, or other parts of the body. Examples of MSDs include carpal tunnel syndrome and tendonitis.
While researchers are not able to definitively answer many questions about MSDs, there is a general agreement that certain factors are associated with their occurrence including: preexisting medical and physical conditions, overall health, equipment and body position while doing work, frequency of work, duration of work, and other physical activities that may facilitate the onset of MSDs d. This chapter provides guidelines that may help you work more comfortably and may reduce your risk of MSDse,f.
a. Magnavita, N., L. Bevilacqua, P. Mirk, A. Fileni, and N. Castellino. “Work-related Musculoskeletal Complaints in
Sonologists.” Occupational Environmental Medicine. 41:11 (1999), 981-988.
b. Craig, M. “Sonography: An Occupational Hazard?” Journal of Diagnostic Medical Sonography. 3
(1985),121-125.
c. Smith, C.S., G.W. Wolf, G. Y. Xie, and M. D. Smith. “Muscoskeletal Pain in Cardiac Ultrasonographers: Results of
a Random Survey.” Journal of American Society of Echocardiography. (May1997), 357-362.
d. Wihlidal, L.M. and S. Kumar. “An Injury Profile of Practicing Diagnostic Medical Sonographers in Alberta.”
International Journal of Industrial Ergonomics. 19 (1997), 205-216.
e. Habes, D.J. and S. Baron. “Health Hazard Report 99-0093-2749.” University of Medicine and Dentistry of New
Jersey. (1999).
f. Vanderpool, H.E., E.A. Friis, B.S. Smith, and K.L. Harms. “Prevalence of Carpal Tunnel Syndrome and Other
Work-related Muscoskeletal Problems in Cardiac Sonographers.” Journal of Medicine. 35:6 (1993), 605-610.

G e
S t a r t e
d
Position the System
To promote comfortable shoulder, arm and hand postures, consider the following:
• Use the TITAN mobile docking system to support the weight of the ultrasound system.
To minimize eye strain, consider the following:
• When the exam/procedure allows, position the system within reach.
• Adjust the angle of the system/display to minimize glare from overhead or outside lighting.
To minimize neck strain, consider the following:
• If using a stand, adjust the stand height such that the display is at or slightly below eye level.
Position Yourself
• Use a chair that has support for your lower back.
• Use a chair that adjusts to your work surface height and promotes a natural body posture.
• Use a chair that allows for quick height adjustments.
• Always sit or stand in an upright manner. Avoid bending or stooping.
To minimize reaching and twisting, consider the following:
• Use a bed which is height adjustable.
• Position the patient as close to you as possible.
• Face forward. Avoid twisting your head or body.
• Move your entire body front to back and position your scanning arm next to or slightly in front of you.
• Stand for difficult exams to minimize reaching.
To promote comfortable shoulder and arm postures for your scanning arm, consider the following:
• Keep your elbow close to your side.
• Relax your shoulders in a level position.
• Support your arm using a support cushion or pillow, or rest it on the bed.
To minimize neck bending and twisting, consider the following:
• Position the ultrasound system/display directly in front of you.
• Provide an auxiliary monitor for patient viewing.

G e t t i n
g S t a r t e
d
Go Lightly
To promote comfortable hand, wrist, and finger postures for your scanning arm, consider the following:
• Hold the transducer lightly in your fingers.
• Minimize the pressure applied on the patient.
• Keep your wrist in a straight position.
Take Breaks
Minimizing scanning time and taking breaks can be very effective in allowing your body to recover from physical activity, which can help you avoid any MSDs. Some ultrasound tasks may require longer or more frequent breaks. One way of taking a break is to stop and relax. However, simply changing tasks can help some muscle groups relax while others remain or become active.
To vary your daily activities, consider the following:
• Plan your work so there are breaks in between ultrasound exams.
• Work efficiently when performing an ultrasound exam by using the software and hardware features correctly. Learn more about these features in Chapter 3 of this guide.
• Keep moving. Avoid sustaining the same posture by varying your head, neck, body, arm, and leg positions.
Exercise

G e
S t a r t e
d
The battery comprises six lithium-ion cells plus electronics, a temperature sensor, and battery contacts.
If the battery is being installed for the first time, it will need to be charged.
Figure 1 Insert Battery into System
To install the battery:
1 Turn the system upside down. 2 Place the battery into the battery compartment, at a slight angle. See Figure 1. 3 Slide the battery forward until it locks into place. 4 Push down on the two locking levers to secure battery.
To remove battery:
1 Push up on the two locking levers. 2 Slide the battery back. 3 Lift the battery from the compartment.
Warning: To avoid injury to the operator and to prevent damage to the ultrasound system, inspect the battery for leaks prior to installing.
Locking levers
G e t t i n
g S t a r t e
d
Installing and Removing the CompactFlash Card
Images are saved to a CompactFlash card and are organized in a patient list. The images in the patient list are organized alphabetically by the patient name and ID. Images are archived from the system to a PC using a USB or Ethernet connection. Images on the CompactFlash card cannot be read directly from a CompactFlash card reader.
To install the CompactFlash card:
1 Verify the ejector pin is fully pushed in. 2 Insert the CompactFlash card into the front slot on the ultrasound system. See Figure 1 on
page 3. The front slot is used to store images. The back slot is used to update systems/transducers and to import/export DICOM configuration information and OB Tables.
The CompactFlash card is ready to use when the save icon and the image memory counter, showing the remaining available memory, are displayed on the screen.
To remove the CompactFlash card:
1 Turn off the ultrasound system before removing the card. 2 Press the ejector pin in the front card slot to position it to the outside of the system. See Figure 1
on page 3. 3 Press in the ejector pin to eject the CompactFlash card.
Note: If the CompactFlash card does not eject properly, try a new card.
4 Remove the card. 5 Push in the ejector pin to avoid damaging the ejector pin.

G e
S t a r t e
d
Using AC Power/Charging Battery
The battery charges when the system is connected to the AC power supply. If the system is off and connected to AC power, a completely discharged battery will fully charge in 2.5 to 3.5 hours. If the system is on and connected to AC power, a completely discharged battery will fully charge in 5 to 6 hours.
The system can run on AC power and charge the battery in three ways.
• Connected directly to the system
• Connected to the mini-dock (See the TITAN Accessory User Guide.)
• Connected to the docking system (See the TITAN Accessory User Guide.)
To operate the system using AC power (directly to system):
1 Connect the DC power cable from the power supply to the connector on the system. See Figure 2 on page 4.
2 Connect the AC power cord to the power supply and connect to a hospital-grade electrical outlet.
Turning System On/Off
To turn the system on/off:
1 Locate the Power key on the top left side of the system. See Figure 3 on page 14. 2 Press the Power key once to turn on and once to turn off.
To wake up the system:
To conserve battery life, the system is configured to go into sleep mode. The system goes into sleep mode when the lid is closed or if the system has not been touched for a preset amount of time. Press any key, touch the touchpad, or open the lid to wake up the system. To adjust the time for sleep delay, see “To set up Audio and Battery:” on page 28.
Warning: The equipment shall be connected to a center-tapped single phase supply circuit when users in the United States connect the equipment to a 240V supply system.
Caution: Verify the hospital supply voltage corresponds to the power supply voltage range. See “Electrical” on page 206.

G e t t i n
g S t a r t e
d
To connect the transducer:
1 Turn the system upside down (if not in docking system). 2 Pull the transducer latch up and rotate it clockwise. 3 Align the transducer connector with the connector on the bottom of the system. 4 Insert the transducer connector into the system connector. 5 Turn the latch counterclockwise. 6 Press the latch down, securing the transducer connector to the system.
To remove the transducer:
1 Pull the latch up and rotate it clockwise. 2 Pull the transducer connector away from the system.
Warning: The transducer connector can become hot during operation. This is normal. Operate the system in the docking system or on a flat, hard surface to allow air flow past the connector.

G e
S t a r t e
d
14
15
17
16
18
19
20
5
10
2 Alphanumeric Use to enter text and numbers.
3 Annotation Text Turns the keyboard on and off for text entry.
Picto Turns the pictographs/pictograph marker on and
off.
Arrow Displays an arrow that can be moved and rotated
within the image area.
Depth Up Decreases imaging depth.
Depth Down Increases imaging depth.

G e t t i n
g S t a r t e
d
6 Zoom Magnifies image 2x.
7 Gain Near Adjusts the gain applied to the near field of the
image.
Far Adjusts the gain applied to the far field of the
image.
image.
indicator
A steady green light indicates AC power is connected. A flashing
green light indicates the system is in sleep mode.
9 Caliper/Calcs Caliper activates a measurement caliper on the screen.
Calcs turns the calculation menu on and off.
10 Touchpad Use to select, adjust, and move objects on the screen.
11 Select Use to switch between frozen images in duplex and dual screens.
color and Doppler menus, calipers for measurement (calipers),
pictograph marker position/angle (picto), arrow
position/orientation (arrow).
measurements/calculation to the report when configured in
system setup.
14 Remappable
Controls features on the context menu which are adjusted based
on the system state.
Report Access to the patient report.
Review Access to the patient list and saved patient
images, and archive functions.
Patient Access to patient information.
16 (Delta key) Use as a shortcut to existing functionality in the system.
17 Video recording Record Turns VCR record on and off.
Save Clip (Not available.)
Number System Control Description
G e
S t a r t e
d
Figure 4 Screen Layout
18 Freeze Freeze Stops the live imaging and displays a frozen
image.
(back/forward) back/forward through last-in, first-out sequence.
All mode images can be stored and reviewed in
the cine buffer.
19 Update Toggles between dual and duplex screens and image modes in
M Mode and Doppler, e.g., between 2D Doppler sample line and
Doppler spectral trace.
20 Modes M Mode Turns M Mode on and toggles between M Mode
sample line and the M Mode trace.
Doppler Turns Doppler on and toggles between Doppler
sample line and the Doppler trace.
Color Turns CPD/DCPD/Color on and off.
2D Turns 2D on.
Number System Control Description
G e t t i n
g S t a r t e
d
Number Key Description
1 Mode Data Displays current imaging mode information, e.g., Gen, Res,
THI, and PW.
images, the orientation marker is green on the active screen.
3 Text Displays text entered using keyboard.
4 Picto Displays pictograph to indicate anatomy and transducer
position.
6 Image Displays ultrasound image.
7 Measurement
Displays current measurement and calculation data.
8 Context Menu Provides context sensitive controls based on the system
state.
9 Patient Header Displays current patient name, ID number, institution,
sonographer, and date/time.
10 System Status Displays information related to system status, e.g., exam
type, transducer, and AC connected.
11 Depth Marker Displays marks in .5 cm, 1 cm, and 5 cm increments
depending on the depth.
G e
S t a r t e
d
Touchpad
The touchpad is used to select, adjust, and move objects on the screen. For example, it controls the caliper position, CPD/DCPD/Color box position and size, floating cursor, and more.
Note: The arrow keys control much of the same functionality as the touchpad.
Context Menus
The context menu, located at the bottom of the screen, provides controls that can be adjusted based on the system state. For example, in 2D with a C60 transducer attached, the following options are available:
Table 3: Context Menus
Icon Description Values Types
L/R Flips the image left or right Action
U/D Flips the image up or down Action
Brightness Controls display brightness 1-10 Up-Down
Biopsy Turns biopsy guidelines on or off On-Off
Dual Displays side-by-side images. On-Off

G e t t i n
g S t a r t e
d
Remappable Controls
The remappable controls consists of six sets of 2-button groups at the top of the control panel. They adjust the values of each control displayed in the context menu. The buttons function in one of four ways, depending on context.
Annotation and Text
Control Description
Cycle Moves through a list of values, then begins again when the bottom or
top of the list is reached.
Up-Down Stops at the top and bottom of a value list, not allowing user to go from
the first to last or last to first value in one button press.
On-Off Turns available features on or off depending on their current state.
Action Performs some action related to an object on the screen.
3
4
5
1 f Function key used with numbered key to display predefined text.
2 Tab Moves cursor among fields in the forms and tabs between text
position in dual screens.
4 Shift Allows entry of capitalized characters and international characters.

G e
S t a r t e
d
Symbols
Symbols/special characters can be entered in selected fields and forms:
• Patient Information: Last, First, Middle, ID, Accession, Indications, Procedure ID, Sonographer, Reading Dr., Referring Dr., and Institution.
• Connectivity (DICOM) Configure: Alias, AE Title.
• Delta Key, F Keys: f1—f0.
• Text mode (Imaging): Annotation field.
Figure 6 Symbols/Special Characters
To enter a symbol/special character:
1 Select the desired field and then select Symbols. 2 Click the desired symbol/character.
In the Symbols dialog box, the keyboard controls may also be used. 3 Click OK.
6 Picto Turns pictographs on and off.
7 Arrow Displays an arrow that can be moved and rotated within the image
area.
8 Spacebar Turns the keyboard on for text entry or adds a space.
9 Delete Removes one character to the right of the cursor during text entry.
10 Arrow keys Moves highlighted selection in calculations menus, moves cursor
one space when entering text, moves caliper position, and moves
among pages in image review and reports.
11 Backspace Removes one character to the left of the cursor in text entry mode.
12 Enter Moves cursor among fields in forms and saves calculations to
report.
G e t t i n
g S t a r t e
d
Forms A floating cursor is available in the setup, patient, and report forms. The floating cursor allows interaction to occur using the touchpad and the Select key. For example, in the patient form, placing the floating cursor over the last name field and pressing the Select key will activate that field. Additionally, the floating cursor can be used to interact with the list and check boxes.
System Setup System setup is used to customize the system. Press the Setup key to access and set up the following system functions:
Administration Configure system to protect patient data by requiring users to log on
and enter passwords.
Audio, Battery Configure for type of Audio alert, Sleep delay, and Power delay.
Connectivity Configure Printer, Video mode, Serial Port, and Transfer Mode:
DICOM or SiteLink.
Date and Time Configure Date and Time functions.
Delta Key, F Keys Configure existing system functionality as a shortcut and create
predefined labels for images.
mode data, and system status data.
OB Calculations Select OB calculation authors.
OB Custom
(OB Custom Measurements are an optional feature.)
Presets Configure Preset functions: Doppler Scale, Duplex, Live Trace,
Thermal Index, and Save Key.
System Information Displays system hardware and software versions.

G e
S t a r t e
d
To setup security settings:
SonoSite provides a comprehensive set of tools on the TITAN system that allows its customers to meet the applicable security requirements listed in the HIPAA standard. SonoSite's customers are ultimately responsible for ensuring the security and protection of all electronic protected health information collected, stored, reviewed and transmitted on the TITAN system.
Figure 7 Setup Screens: Administration and Administrator Information
Warning: Health care providers who maintain or transmit health information are required by the Health Insurance Portability and Accountability Act (HIPAA) of 1996 and the European Union Data Protection Directive (95/46/EC) to implement appropriate procedures: to ensure the integrity and confidentiality of information; to protect against any reasonably anticipated threats or hazards to the security or integrity of the information or unauthorized uses or disclosures of the information.

G e t t i n
g S t a r t e
d
Password
1 In User Information, enter your new password in the Password field.
2 Enter the password again in the Confirm field. To ensure passwords are secure, it is recommended that passwords contain characters from the following categories: • Upper case characters: A-Z
• Lower case characters: a-z
Note: The password is case-sensitive.
3 In Password changes, click on the check box to allow users access to change their password or leave unchecked to restrict access. (Optional)
4 Select Save.
User Login Setting 1 In the User Login list, select On or Off. • Selecting On restricts access to the TITAN system and
requires the user to enter a user name and password.
• Selecting Off allows access to the TITAN system and does not require the user to enter a user name and password.

G e
S t a r t e
d
Figure 8 Setup Screen: User List Information
Add New User 1 Select New. 2 In User Information, enter information in Name, Password, and
Confirm fields. To ensure passwords are secure, it is recommended that passwords contain characters from the following categories: • Upper case characters: A-Z
Note: The name and password are case-sensitive.
3 In Sonographer, enter the user’s initials to display the information in the patient header and the sonographer field in the Patient Information form. (Optional)
4 In Administration Access, click the check box to allow users access to all administration privileges or leave unchecked to restrict access. (Optional)
5 Select Save.
Information
1 In the User List, select desired user name. 2 Enter the new name. 3 Enter the new password and confirm. 4 Select Save.
Any change to the user name replaces the old name.
Delete User 1 In the User List, select the desired user name. 2 Select Delete.

G e t t i n
g S t a r t e
d
To export or import user accounts:
Note: Export and import are used to configure multiple systems and to back up user account information.
Change User Password 1 In the User List, select the desired user name. 2 Enter the new password and confirm. 3 Select Save.
Done To return to live imaging.
Export User Account 1 Insert the CompactFlash card in the back slot of the TITAN system. See “Installing and Removing the CompactFlash Card” on page 11.
2 Press the Setup key. 3 Select Administration. 4 Select Export from the on-screen menu.
All user names and passwords are copied to the CompactFlash card.
5 Remove the CompactFlash card.
Import User Account 1 Insert the CompactFlash card in the back slot of the TITAN system. See “Installing and Removing the CompactFlash Card” on page 11.
2 Press the Setup key. 3 Select Administration. 4 Select Import from the on-screen menu.
A dialog box is displayed. 5 After all user names and passwords are imported, the system
restarts.
Note: All user names and passwords currently on the system are replaced with the imported date.

G e
S t a r t e
d
To view, export, and clear event log:
The Event Log collects errors and events and can be exported to a CompactFlash card and read by a CompactFlash card reader.
Figure 9 Event Log
Event Log 1 Press the Setup key. 2 Select Administration. 3 Select Log from the on-screen menu.
The Event Log is displayed. 4 Select Back to return to the previous menu.
Export Event Log Note: The Event log and the DICOM network log have the same filename (log.txt). When you export either one to the same CF card, it will overwrite the existing log.txt file.
1 Insert the CompactFlash card in the back slot of the TITAN system.
2 Select Log and then Export from the on-screen menu. 3 View the files on a CompactFlash card reader.
The log is a text file that can be opened by a text file application, e.g., Microsoft Word or Notepad. The log file is named log.txt.

G e t t i n
g S t a r t e
d
Figure 10 User Login and Change Password
Note: User Login is displayed when system access is turned on.
User Login In User Login, enter Name and Password and click OK.
Guest Login In User Login, select Guest.
In Guest mode the user is able to scan but is restricted from accessing system setup and patient information.
Change
Password
1 In User Login, select Password. 2 Enter your old password, new password, confirm the new password and
then click OK. To ensure passwords are secure, it is recommended that passwords contain characters from the following categories: • Upper case characters: A-Z

G e
S t a r t e
d
To set up Audio and Battery:
Figure 11 Setup Screen: Audio, Battery
Key click 1 Press the Setup key. 2 Select Audio, Battery. 3 In the Key click list, select On or Off.
Beep alert 1 Press the Setup key. 2 Select Audio, Battery. 3 In the Beep alert list, select On or Off.
Sleep delay 1 Press the Setup key. 2 Select Audio, Battery. 3 In the Sleep delay list, select Off, 5, or 10 minutes.
Power delay 1 Press the Setup key. 2 Select Audio, Battery. 3 In the Power delay list, select Off, 15, or 30 minutes.

G e t t i n
g S t a r t e
d
Figure 12 Setup Screens: Connectivity and Ethernet
Printer 1 Press the Setup key. 2 Select Connectivity. 3 In the Printer list, select the desired printer from the list of
recommended printers.
Video mode 1 Press the Setup key. 2 Select Connectivity. 3 In the Video mode list, select NTSC or PAL for the desired
mini-dock video output.
Serial Port 1 Press the Setup key. 2 Select Connectivity. 3 In the Serial Port list, select VCR, DVD, or Computer (PC). 4 Restart the system to activate VCR or DVD connectivity. 5 Attach a serial cable (RS-232) to the serial port from the TITAN
mini-dock/TITAN docking system to the VCR, DVD, or PC.
Note: If PC is selected, the system allows report data to be sent as ASCII text from the TITAN system to a PC. Special third party software must be on the PC to acquire, view, or format the data into a report. Check the compatibility of your software with SonoSite technical support.
Transfer Mode 1 Press the Setup key. 2 Select Connectivity. 3 In the Transfer Mode list, select DICOM or SiteLink.
After changing connectivity, a dialog box is displayed to restart the system.

G e
S t a r t e
d
Ethernet Connectivity 1 Press the Setup key. 2 Select Connectivity. 3 In the Transfer Mode list, select SiteLink.
After changing connectivity, a dialog box is displayed to restart the system.
Ethernet Setup 1 Press the Setup key. 2 Select Connectivity. 3 Select Ethernet Setup. 4 Enter information in the following fields: (see DICOM chapter
for definition of terms) • Host Name
• IP Address
• Subnet Mask
• Default Gateway
• Alternate Gateway

G e t t i n
g S t a r t e
d
Figure 13 Setup Screen: Date and Time
Warning: An accurate date and time are critical for accurate obstetrics calculations. Verify that the date and time are accurate before each use of the system. The system does not automatically adjust for daylight savings time changes.
Date 1 Press the Setup key. 2 Select Date and Time. 3 In the Date field, enter the current date (year, month, and day).
Time 1 Press the Setup key. 2 Select Date and Time. 3 In the Time field, enter the current time in 24 hour format (hours
and minutes).

G e
S t a r t e
d
To set up Delta Key and F Keys:
Figure 14 Setup Screen: Delta Key, F Keys
Delta Key 1 Press the Setup key. 2 Select Delta Key, F Keys. 3 Select desired functionality for the Delta key.
The Delta key will now control this function.
F Keys 1 Press the Setup key. 2 Select Delta Key, F Keys. 3 Type desired text. Use the Backspace key or Delete key to
correct mistakes.

G e t t i n
g S t a r t e
d
Figure 15 Setup Screen: Display Information
Patient Header 1 Press the Setup key. 2 Select Display Information. 3 Select the desired check boxes to display desired information in
the patient header.
Mode Data 1 Press the Setup key. 2 Select Display Information. 3 Select the desired check boxes to display imaging information
on the screen.
System Status 1 Press the Setup key. 2 Select Display Information. 3 Select the desired check boxes to display the system status on
the screen.

G e
S t a r t e
d
Gestational Age
Growth Analysis
1 Press the Setup key. 2 Select OB Calculations. 3 In Gestational Age or Growth Analysis lists, select the desired
OB authors. Selecting an author places the measurement on the calculation menu and selecting None removes the measurement from the calculation menu.
More... More... displays the list of user defined custom measurements and allows you to associate a custom table for the custom measurement. This is only available when a user defined custom table has been created for the custom measurement.
Export 1 Insert a blank CompactFlash card in the back slot of the TITAN system.
2 Press the Setup key. 3 Select OB Calculations. 4 Select Export from the on-screen menu.

G e t t i n
g S t a r t e
d
Import 1 Insert the CompactFlash card in the back slot of the TITAN system.
2 Press the Setup key. 3 Select OB Calculations. 4 Select Import from the on-screen menu. 5 After all user defined tables and measurements are imported,
the system restarts.
Note: All user defined tables and measurements currently on the system are replaced with imported data.
6 Select Done from the on-screen menu to return to live imaging.
Tables... Tables... displays system OB tables or is used to create custom OB tables. See “To view and set up OB custom tables:” on page 37.
Reset To return settings for this setup page to factory default, select Reset from the on-screen menu.
G e
S t a r t e
d
Figure 17 Setup Screen: OB Custom Measurements
OB Custom
Measurements
1 Press the Setup key. 2 Select OB Custom Meas. 3 Select New. 4 In the Name field, enter a unique name. 5 In the Type list, select the desired measurement type. 6 Select Save.
The new measurement is displayed in the calculations menu and the OB report. Up to five custom measurements may be saved.
Delete OB Custom
Measurement
1 Press the Setup key. 2 Select OB Custom Meas. 3 In the Custom Measurements list, highlight the last
measurement. 4 Select Delete Last.
Note: If associated tables and report data exist for the measurement, they will be removed from the system.
Tables... Select Tables... from the on-screen menu to create Gestational Age tables for a custom OB measurement. See “To view and set up OB custom tables:”.
G e t t i n
g S t a r t e
d
Figure 18 Setup Screen: OB Custom Table
Age Table Measurements: The system provides gestational age measurements by selected authors for the age table measurements listed in Table 6.
Growth Analysis Table Measurements: The system provides growth graphs or curves for the growth table measurements listed in Table 6.
Table 6: OB Custom Table Measurements
Age Table Measurements GS, CRL, BPD, OFD, HC, TTD, AC, FTA, FL,
5 additional custom measurement labels
Growth Analysis Table Measurements BPD, HC, AC, FL, EFW
Warning: Prior to use, verify custom table data entries are correct. The system does not confirm the accuracy of the custom table data entered by the user.
View OB Tables 1 Press the Setup key. 2 Select OB Custom Meas. or OB Calculations. 3 Select Tables... from the on-screen menu. 4 Select the desired table (Age or Growth) and
measurement/author.
G e
S t a r t e
d
Tables
1 Press the Setup key. 2 Select OB Custom Meas. or OB Calculations. 3 Select Tables... from the on-screen menu. 4 Select the desired table (Age or Growth). 5 In the measurement list, select the desired measurement for the
custom table. 6 Select New from the on-screen menu. 7 In the Author field, enter a unique name. 8 Enter the data. 9 Select Save from the on-screen menu.
Two custom tables may be created for each OB measurement.
Note: To display the measurement for the custom table in the calculation menu, see “To set up OB calculations authors:” on
page 34 and select More...
Note: Growth analysis tables cannot be created for custom OB measurements.
Edit OB Custom Tables 1 Press the Setup key. 2 Select OB Custom Meas. or OB Calculations. 3 Select Tables... from the on-screen menu. 4 Select the desired custom OB table. 5 Select Edit and enter data and then select Save from the
on-screen menu.
Tables
1 Press the Setup key. 2 Select OB Custom Meas. or OB Calculations. 3 Select Tables... from the on-screen menu. 4 Select the desired custom OB table. 5 Select Delete from the on-screen menu to remove the custom
table from the system.
G e t t i n
g S t a r t e
d
Figure 19 Setup Screen: Presets
Doppler Scale 1 Press the Setup key. 2 Select Presets. 3 In the Doppler Scale list, select cm/s or kHz.
Duplex 1 Press the Setup key. 2 Select Presets. 3 In the Duplex list, select desired image display.
• Full 2D, Full Trace
• 1/3 2D, 2/3 Trace
• 1/2 2D, 1/2 Trace
Live Trace 1 Press the Setup key. 2 Select Presets. 3 In the Live Trace list, select Peak or Mean.
Thermal Index 1 Press the Setup key. 2 Select Presets. 3 In the Thermal Index list, select TIS, TIB, or TIC.
Save Key 1 Press the Setup key. 2 Select Presets. 3 In the Save key list, select Image Only or Image/Calcs to
designate the function of the Save key. • Selecting Image Only allows the Save key to save the
image to the CF card.

G e
S t a r t e
d To view System Information:
Figure 20 Setup Screen: System Information
To change system setups to the default settings:
1 Turn the system off. 2 Connect the system to AC power. See “To operate the system using AC power (directly to
system):” on page 12. 3 Simultaneously press and release 1 and the Power key.
The system beeps several times and then the image display appears with all default settings.
Note: Default settings can not be changed by the user. Default settings are set at the factory.
Reset To return settings for this setup page to factory default, select Reset from the on-screen menu.
System Information 1 Press the Setup key. 2 Select System Information from the on-screen menu.
Note: To install a license key see “Installing a License Key” on page 170.
Chapter 3: Imaging
Patient Information The patient information form allows information to be entered into the system for the patient exam. Information which can be entered includes patient demographics, exam information, and clinical information. This information is automatically placed on the last page of the patient report. Once a patient is entered, all saved images will be linked to that patient. To end the exam, a New Patient can be created or End Exam can be selected.
Note: Patient information can be edited during the exam by pressing the Patient key. However, if the patient name, ID, or Accession changes, a new patient is created.
Figure 1 Patient Information Form
New
Patient
1 Press the Patient key. 2 Select New from the on-screen menu.
This clears the existing patient information.
Note: New patient will erase any previously entered information, including any calculations and report pages. To save this information, save the screen for each item, e.g. report pages, patient information, calculations, and graphs.
3 Enter information into appropriate fields. The patient information fields vary based on the selected exam type.
• Patient
• Accession: Enter number, if applicable.
• Date of birth: Enter (YYYY/MM/DD).
• Gender: Select Female, Male, other, or leave blank.
• Indications: Enter desired text.
• Type: Select desired exam type.
• LMP or Estab. DD: Enter either last menstrual period or established due date (YYYY/MM/DD). (Estab.DD only in OB exam.)
Note: The date for LMP must precede the current system date.
• Twins: Select the Twins check box to display Twin A and Twin B measurements on the calculation menu (only in OB exam and report).
• Previous Exams: Enter data from previous exams (only in OB exam).
• HR: Enter the Heart Rate (only in vascular exam). If the heart rate is obtained and saved using M Mode, the values will override the number entered on the patient information screen.
• BP: Enter blood pressure (only in vascular exam).
• Symbols (See “Symbols” on page 20.)
• More...
• Institution: Enter name.
Note: All patient information can be edited up until the first image is saved. After the first image is saved, the Patient Name, ID, and Accession number cannot be modified. Modifying these fields closes the current
patient exam and starts a new exam.
Select Done from the on-screen menu to save information and return to previous menu.
• Previous Exams...(only in OB exam).
• Enter data from previous exams. Data from five previous exams may be entered.
• For twins, select Twin A/B from the on-screen menu to enter data for each twin.
Note: The date for a previous exam must precede the current system date.
Select Done from the on-screen menu to save information and return to previous menu.
End Exam 1 Press the Patient key. 2 Select End Exam from the on-screen menu to close the current patient
exam.

g
Transducer, Exam Type, and Imaging Mode The system has various configurations and options. All are described in this user guide and may not apply to your system. System features are dependent on your configuration, transducer, and exam type.
The following table describes the abbreviations for exam types.
Cancel Select Cancel from the on-screen menu to undo any changes to the patient information form and return to the previous imaging state.
Pressing Cancel will not close the current patient exam.
Done Select Done from the on-screen menu to save information and return to the previous imaging state.
Information is saved when exiting the patient information form unless Cancel is selected from the on-screen menu.
Note: If any changes are made to the current patient’s name, ID, or accession number, that patient exam will be closed and a new one will be started.
Warning: The diagnostic capability differs for each transducer, exam type, and imaging mode. Verify your system’s capabilities prior to diagnosis.
Transducers have been developed to specific criteria depending on their application. This criteria includes biocompatability requirements.
Table 1: Exam Type Abbreviations
Abbreviation Exam Type
i n g
The following table describes the transducer’s exam type, imaging mode, and optimization that may be available with your system.
The optimization settings for 2D are Res, Gen, and Pen.
The optimization settings for color power Doppler (CPD), directional color power Doppler (DCPD), and color Doppler (Color) are low, medium, and high (flow sensitivity) with a range of PRF settings for Color depending on the application.
Sup Superficial
Vas Vascular
Abbreviation Exam Type
Imaging Mode
Transducer Exam Type 2D THI CPD DCPD Color M Mode PW CW
C8 Prostate X X X X
Gyn X X X X
OB X X X X
C11 Vascular X X X X X
Cardiac X X X X X
Neonatal X X X X X
Abdomen X X X X X
C15 Abdomen X X X X X X
OB X X X X X X
Cardiac X X X X X X
C60 OB X X X X X X
Gyn X X X X X X
Abdomen X X X X X X
HST Superficial X X X X X
Muscle X X X X X
Vascular X X X X X

Transducer Preparation
Acoustic coupling gel must be used during exams. Although most gels provide suitable acoustic coupling, some gels are incompatible with some transducer materials. SonoSite recommends Aquasonic® gel and a sample is provided with the system.
General Use
OB X X X X X
L25 Nerve X X
Vascular X X X X X
Warning: Some transducer sheaths contain natural rubber latex and talc, which can cause allergic reactions in some individuals. Refer to 21 CFR 801.437, User labeling for devices that contain natural rubber.
Caution: Using gels not recommended for your transducer can damage it and void the warranty. If you have questions about gel compatibility, contact SonoSite or your local representative.
SonoSite recommends you clean transducers after each use. Refer to “Cleaning and Disinfecting Transducers” on page 173 for cleaning and disinfecting procedures.
Table 2: Transducer, Exam Type, and Imaging Mode (Continued)
Imaging Mode
Transducer Exam Type 2D THI CPD DCPD Color M Mode PW CW

Install Transducer
Note: SonoSite recommends the use of market-cleared, transducer sheaths for clinical applications of an invasive nature (such as transvaginal).
1 Place gel inside the sheath. 2 Insert the transducer into the sheath.
Note: To lessen the risk of contamination, install the sheath only when you are ready to perform the procedure.
3 Pull the sheath over the transducer and cable until the sheath is fully extended.
4 Secure the sheath using the bands supplied with the sheath. 5 Check for and eliminate bubbles between the footprint of the
transducer and the sheath.
Note: If any bubbles are present between the footprint of the transducer and the sheath, the ultrasound image may be affected.

2D Imaging
The system has advanced image optimization technology that greatly simplifies user controls. To achieve the best possible image quality, it is important to properly adjust the display brightness, gain, depth settings, and exam type.
It is also important to select an optimization setting that best matches your needs.
The system has a high-performance, liquid crystal display (LCD). To optimize image quality, adjust the display for viewing angle, and brightness.
Each time you turn the system on, the 2D image is displayed. It displays echoes in two dimensions on the display by assigning a brightness level based on the echo signal amplitude. This is the system’s default imaging mode. When imaging in another mode, you may return to 2D imaging by pressing the 2D key. If the system does not return to 2D imaging after pressing the 2D key, ensure the system is in live imaging.
Figure 3 2D Image
Optimize Select the desired optimization setting from the on-screen menu.
• Res provides the best possible resolution.
• Gen provides a balance between resolution and penetration.
• Pen provides the best possible penetration.
Note: Some of the parameters that are optimized to provide the best image include: focal zones, aperture size, frequency (center and bandwidth), dynamic range, and waveform. They cannot be adjusted by the user.
Horizontal
Flip
Select left or right flip from the on-screen menu to change image orientation.
Vertical
Flip

i n g
Brightness Select the desired brightness setting from the on-screen menu to adjust display brightness (1-10).
Note: The display brightness affects battery life. To conserve battery life, adjust brightness to a lower setting.
Biopsy Select Biopsy from the on-screen menu to display biopsy guidelines. Select again to turn off. See “Biopsy” on page 59 and Biopsy User Guide for more information.
Note: The feature is dependent on transducer and exam type.
Note: Biopsy is not available when ECG cable is connected.
Guide
Select Guide from the on-screen menu to display guide.
Select again to turn off. See the L25 Bracket and Needle Guide User Guide for more information
ECG Note: This option requires a SonoSite ECG cable.
1 Connect the ECG cable. See the TITAN Accessories User Guide. 2 Select ECG from the on-screen menu to display the ECG trace. See
“ECG Monitoring” on page 57.
Dual
Images
1 Select Dual from the on-screen menu to display side by side 2D images.
2 Press the Update key to display the second screen and to toggle between the screens. With both images frozen, press the Update key to toggle between the images, except if calipers, calcs, arrow, or picto are displayed. Select Dual from the on-screen menu or press the 2D key to return to full screen 2D imaging.
Gain Turn the Near, Far, or Gain knobs (on the lower left side of the control panel) to increase or decrease the amount of gain applied to the near field, far field, or the overall image (near and far correspond to the time gain compensation (TGC) controls found on other ultrasound systems).
Depth Press the Depth key up to decrease or down to increase the displayed depth. As you adjust the depth, the maximum depth number changes in the lower right corner of the screen.
Note: The vertical depth scale is marked in .5 cm, 1 cm, and 5 cm increments depending on the depth.
Tissue
Harmonic
Imaging
Note: This is an optional feature and is dependent on transducer and exam type.
1 Press the THI key to turn on THI. THI is displayed in the top left portion of the screen next to the optimization setting.

g
Zoom Note: Zoom is only available during real-time imaging. You cannot zoom on a frozen or saved image.
1 Press the Zoom key. The image is magnified by a factor of two from the center of the image.
Note: You can change the depth while the image is zoomed.
2 Press the Zoom key again to exit zoom.
Freeze 1 Press the Freeze key. The cine icon and frame number are displayed in the system status area of the screen.
2 Press the Freeze key again to return to live imaging. The cine icon is removed from the system status area of the screen and live imaging begins.
Cine Buffer On a frozen image, press the Cine keys to view individual frames in the cine buffer.
The frame number will change dynamically as the cine key is pressed.

i n g
M Mode Imaging
The following instructions cover Motion mode (M Mode) imaging. Refer to “2D Imaging” on page 47 for instructions about depth and optimization.
M Mode Sample Line
Sample
Line
1 Press the M Mode key for the M Mode sample line.
Note: If M Mode does not come on, make sure the system is in live imaging.
2 Use the touchpad to position the M Mode sample line over the area of interest on the image.

M Mode
Trace
1 Press the M Mode key again to acquire the M Mode trace.
Note: The time scale at the top of the trace has small marks at 200 ms intervals and large marks at one second intervals.
2 Press the Update key to toggle between the sample line and trace. 3 In duplex, press the M Mode key to return to the full screen M Mode
sample line.
Note: You can set up three screen layouts. For duplex imaging see “Duplex” on page 39.
Sweep
Speed
Select the desired sweep speed from the on-screen menu (slow, med, fast).
Gain Turn the Near, Far, or Gain knobs (on the lower left side of the control panel) to increase or decrease the amount of gain applied to the near field, far field, or the overall image (near and far correspond to the time gain compensation (TGC) controls found on other ultrasound systems).
Freeze 1 Press the Freeze key. 2 Press the Freeze key again to return to live imaging.
The cine icon is removed from the system status area of the screen and live imaging begins.
Note: Press the M Mode or Update key to display the associated frozen 2D image with the M Mode sample line.
Cine Buffer On a frozen image, press the Cine keys to view the trace at different points in time.
2D
Imaging

i n g
Color Doppler Imaging
Note: Color power Doppler (CPD), directional color power Doppler (DCPD), and color Doppler (Color) are optional features and are dependent on transducer and exam type.
The following instructions cover CPD, DCPD, and Color imaging.
Figure 6 Color Image
CPD, DCPD,
or Color
1 Press the Color key for CPD, DCPD, or Color. A region of interest (ROI) box is displayed in the center of the 2D image.
2 Select CPD, DCPD, or Color from the on-screen menu. The current setting is displayed in the upper left corner of the screen and in the on-screen menu. In DCPD and Color mode, the color indicator bar is displayed in the upper left corner of the screen. The color bar displays velocity in cm/s.
Flow
Sensitivity
• Low optimizes the system for low flow states.
• Med optimizes the system for medium flow states.
• High optimizes the system for high flow states.
The current setting is displayed in the top left portion of the screen and in the on-screen menu.
PRF Scale
(Color
only)
Select the desired pulse repetition frequency (PRF) setting from the on-screen menu.
Note: There is a wide range of PRF settings for each flow sensitivity selection.
Wall Filter
(Color
only)

Select the desired steering angle setting from the on-screen menu.
This automatically changes pulsed wave (PW) Doppler angle correction to the optimum setting.
• Steering angle of -15 degrees has an angle correction of -60 degrees.
• Steering angle of 0 degrees has an angle correction of 0 degrees.
• Steering angle of +15 degrees has an angle correction of +60 degrees.
Note: If two modes are active (CPD/DCPD/Color and PW Doppler) press the Select key to toggle between the on-screen menus.
Variance
(Cardiac
only)
Select variance from the on-screen menu to turn on.
Invert Select Invert from the on-screen menu to switch the displayed direction of flow.
Note: Invert is only displayed when DCPD/Color is selected.
ROI Box 1 Use the touchpad to position or change the size of the region of interest (ROI) box. While you are moving or changing the size of the ROI box, you will see a green outline of the new position or the new size as it moves on the display.
2 Press the Select key to toggle between the position and size of the ROI box. The ROI box indicator on the left side of the screen is highlighted green to show which function the touchpad is controlling.
Gain Turn the Gain knob (on the lower left side of the control panel) to increase or decrease the amount of color gain applied to the CPD, DCPD, or Color ROI box.
Note: While in CPD, DCPD, or Color imaging, Near and Far knobs affect only the 2D image.
2D
Imaging
Press the 2D or Color key to return to 2D imaging.

Pulsed Wave (PW) and Continuous Wave (CW) Doppler Imaging
Note: PW Doppler and CW Doppler are optional features and are dependent on transducer and exam type.
The following instructions cover PW and CW Doppler imaging.
Doppler Sample Line
Figure 7 Doppler with Sample Line Image and ROI Box
Sample
Line
1 Press the Doppler key for the Doppler sample line. 2 Use the touchpad to position the Doppler sample line over the area
of interest on the image. 3 Press the Select key to set sample line and to toggle between Doppler
sample line and Angle Correction. An indicator on the left side of the screen is highlighted green to show which function the touchpad is controlling.
Note: If PW or CW Doppler mode does not come on, make sure the system is in live imaging.
Note: The color ROI box is tied to the PW or CW sample line.
PW/CW
Doppler
1 Press the Doppler key. 2 Select PW from the on-screen menu to toggle between PW Doppler
and CW Doppler (CW Doppler only in cardiac exams).

Angle
Correction
(PW only)
There are two ways to adjust the angle correction in PW Doppler imaging.
Select Angle Correction from the on-screen menu to adjust the angle correction to 0, +60, or -60 degrees.
OR
1 Press the Select key to highlight the angle correction icon displayed on the left side of the screen. The indicator is highlighted green to show which function the touchpad is controlling.
2 Use the touchpad to adjust the angle in two degree increments from -74 to +74 degrees.
3 Press the Select key again to set the desired angle.
Gate Size
(PW only)
Select the desired gate size setting from the on-screen menu.
Note: Gate size options vary with transducer and exam type.
Steering
Select the desired steering angle setting from the on-screen menu.
This automatically changes PW angle correction to the optimum setting.
• Steering angle of -15 degrees has an angle correction of -60 degrees.
• Steering angle of 0 degrees has an angle correction of 0 degrees.
• Steering angle of +15 degrees has an angle correction of +60 degrees.
Note: The angle correction can be adjusted manually after steering has been selected. (See “Angle Correction (PW only).” )
Note: If two modes are active (CPD/DCPD/Color and PW/CW Doppler) press the Select key to toggle between on-screen menus.
Spectral
Trace
1 Press the Doppler key again to acquire the Doppler trace. 2 Press the Update key to toggle between the 2D/sample line and
trace. 3 In duplex, press the Doppler key to return to the full screen Doppler
sample line. The on-screen menu options for Doppler spectral trace are:
• Scale
• Baseline
• Invert
• Volume
• Live Trace (peak or mean)
Note: The time scale at the top of the trace has small marks at 200 ms intervals and large marks at one second intervals.
Note: You can set up three screen layouts. For duplex imaging see “Duplex” on page 39.
Scale Select the desired scale/pulse repetition frequency (PRF) setting from the on-screen menu.
Line Select the desired baseline position from the on-screen menu.
Note: Baseline can be adjusted on a frozen trace, if Live Trace is not displayed.
Invert Select Invert from the on-screen menu to vertically flip the spectral trace.
Note: Invert can be adjusted on a frozen trace, if Live Trace is not displayed.
Volume Select the desired Doppler volume setting from the on-screen menu to increase or decrease Doppler speaker volume (0-10).
Wall Filter Select the desired wall filter setting from the on-screen menu (low, med, high).
Sweep
Speed
Select the desired sweep speed from the on-screen menu (slow, med, fast).
Live Trace Select Trace from the on-screen menu to display a live trace of the peak or mean. See “Live Trace” on page 39.
Gain Turn the Gain knob to increase or decrease the amount of Doppler gain.

ECG Monitoring Note: This option requires a SonoSite ECG cable.
Cine Buffer On a frozen image, press the Cine keys to view the trace at different points in time.
2D
Imaging
Press the 2D key to return to 2D imaging.
Warning: To prevent misdiagnosis, do not use the ECG trace to diagnosis cardiac rhythms. The SonoSite ECG option is a non-diagnostic feature.
To prevent misdiagnosis, do not use the SonoSite ECG option for long term cardiac rhythm monitoring.
Caution: Use only accessories recommended by SonoSite with the system. Your system can be damaged by connecting an accessory not recommended by SonoSite.
ECG Note: This menu option is displayed only when the ECG cable is connected.
1 Connect the ECG cable to the ECG connector on the docking system/mini-dock/TITAN system. See the TITAN Accessories User Guide.
Note: When the ECG cable is connected, ECG monitoring turns on automatically.
Note: Biopsy guidelines are not available when ECG is connected.
2 Select ECG from the on-screen menu.
Show/Hide Select show/hide from the on-screen menu to turn on/off ECG trace.
Gain Select the desired gain from the on-screen menu to increase or decrease ECG gain (1-20).
Position Select the desired position of the ECG trace from the on-screen menu.
Sweep
Speed

i n g
Annotation Note: In a single image, you can only enter annotation in one row across the top of a frozen or live image. In Dual image you can only enter text in one row across the bottom of each section of the screen. Annotation is available in both live imaging and on a frozen image. You cannot annotate on a saved image.
Enter Text 1 Press the Text key or the Spacebar key. In a single image a green data entry cursor is displayed in the upper left corner.
2 Use the keyboard to enter, delete, or modify text. • Press the Backspace key to delete characters to the left of the
cursor.
• Press the Space key to add spaces between words or replace characters with blank spaces to the right of the cursor.
• Press the Arrow keys to move the cursor to the left or right.
• Press the Enter key to return the cursor to the beginning of the line of text.
• Press the Delete key to delete characters to the right of the cursor.
• Select Delete Line from the on-screen menu to remove the entire line of text.
• Select Symbols from the on-screen menu to enter special characters. See “Symbols” on page 20.
• Press the Text key to turn off text entry.
Arrow 1 Press the Arrow key. Use the arrow as a pointer to bring attention to a specific part of the image.
2 Use the touchpad to move the arrow over the image. 3 Press the Select key to switch the arrow’s orientation and then use the
touchpad to adjust the arrow’s orientation. 4 Press the Select key again to set the arrow’s orientation and then use
the touchpad to move the arrow over the image. 5 Press the Arrow key to set the arrow.

g
Biopsy The ultrasound system is equipped with a biopsy feature. Biopsy guides are used to assist in the guidance of a biopsy needle. The system generates guidelines that represent the anticipated path of the biopsy needle. The echoes of the anatomical target and the needle are displayed on the system display and assist in guiding the biopsy needle to the target. For detailed instructions on the use of the system and biopsy guide accessories, and a list of compatible transducers, please refer to the Biopsy User Guide.
Pictograph 1 Press the Picto key to turn on the pictograph. The on-screen options for pictograph are:
• Show/Hide
• Done
2 Select the desired pictograph. The first number changes to show which pictograph in a set of pictographs has been selected. The second number shows the total number of pictographs available.
Note: The pictograph set that is available is dependent on transducer and exam type.
3 Use the touchpad to position the pictograph marker. 4 Press the Select key and then use the touchpad to rotate the
pictograph marker. 5 Select Hide from the on-screen menu to remove the pictograph.
F keys 1 Press the Text key or the Spacebar key. A green flashing data entry cursor is displayed in the upper left corner.

Save to CompactFlash
Images are saved to the CompactFlash card. The images in the patient list are organized alphabetically by the patient name and ID. If a name is not entered in the patient name field, a patient exam is created and identified as (_No_Name_). If an ID number is not entered in the ID field, the ID number is identified as (_No_ID_).
To review saved images, see “Image Review” on page 61. The images saved on the CompactFlash card cannot be opened and viewed on a PC. Images may be archived from the ultrasound system using DICOM Image Transfer or to a PC using SiteLink Image Manager 2.2. See “DICOM Connectivity” on page 105 or the SiteLink User Guide.
The number of images saved to the CompactFlash card varies depending on the storage capacity of the card.
Print to Local Printer
Ensure the printer is properly set up for operation with the system. See “Printer” on page 29 for system setting and the TITAN Accessory User Guide for hardware setup.
Warning: To prevent loss of data, loss of images, or damage to the CompactFlash card, turn the ultrasound system off before removing the CompactFlash card. When the CompactFlash card is removed before turning off the ultrasound system, the system must be restarted.
Save Image 1 Verify the CompactFlash card is inserted into the front slot on the ultrasound system. See Figure 1 on page 3.
2 Turn system on. The CompactFlash card is ready to use when the save icon and the image memory counter, showing the remaining available memory, are displayed on the screen.
Note: It may take a few seconds for the image memory counter to display the available memory.
Note: If the CompactFlash card is inserted into the back slot, the save icon and number are not displayed.
3 Press the Save key to save an image to the CompactFlash card. After the audible beep is heard, the next image may be saved. It may take a few seconds for the image memory counter to display the available memory. The image memory indicator decreases by one.
Note: Ensure that there is sufficient memory available on the CompactFlash card before saving additional images.
Print Image Press the Print key.

g
Image Review The patient list displays all the patients who have images saved on the CompactFlash card. Image review is comprised of two parts: the patient list and the patient images. The patient images display images for the current patient or the patient selected from the patient list.
Patient List
Figure 9 Patient List
Patient List Press the Review key. If there is a current patient, select List from the on-screen menu.
Select All,
Deselect
Select All from the on-screen menu to highlight all the entries within the patient list. Deselect removes the highlight from all the entries and highlights the previously selected patient.
Note: Review is disabled when all entries in the list are selected.
Review
Images
Select Review from the on-screen menu to review the images for the currently selected patient.
Archive Select Archive from the on-screen menu to send the selected patient exams to a PC using SiteLink or to a DICOM printer or archiver. See “Transfer Mode” on page 29.
Note: SiteLink and DICOM are optional features.
Print All
Images
1 Verify a printer is selected. See “Printer” on page 29. 2 Press the Review key. 3 Select List from the on-screen menu. 4 Highlight the desired patient.
Note: An individual patient or all patients may be selected.

Figure 10 Patient Images
Delete Select Delete from the on-screen menu to delete the selected patient exam. A confirmation screen is displayed.
Done Select Done from the on-screen menu to exit the patient list and return to the previous imaging state.
Patient
Images
Press the Review key.
If there is not a current patient, highlight the desired patient and select Review from the on-screen menu.
Next or
Previous
Image
Select the Next or Previous Image (1/x) from the on-screen menu to view image.
Patient List Select List from the on-screen menu to display the patient list.
Print Image 1 Verify a printer is selected. See “Printer” on page 29. 2 Select Print from the on-screen menu to print the displayed
image.
Delete Select Delete from the on-screen menu to delete the displayed image. A confirmation screen is displayed.

M e a s . & C a l c
s
Chapter 4: Measurements and Calculations
Measurements Measurements and calculations are performed on frozen images. The following sections explain how to perform basic measurements in each imaging mode. Based on the measurements performed, the SonoSite system automatically calculates specific information and displays the results. Some of the options described in the user guide may not apply to your system. System features are dependent on your configuration, transducer, and exam type.
2D Measurements
The basic measurements that can be performed in 2D are:
• Distance in cm
• Area in cm2
• Circumference in cm

M e a s
Distance
Measurement
1 On a frozen 2D image, press the Caliper key. A set of calipers is displayed on

Titan User Guide

Documents

Transcript of Titan User Guide